Back to Basics

Did the Senate forget they are supposed to be representing the American people and are not on the TV game show “Let’s Make a Deal”?  The health care bill has serious, life-threatening consequences and they are putting their votes up for auction – going to the highest bidder.  Are the rest of the Senators wishing they held out for what was behind door number 3?

It is one thing to hold out to negotiate for a change or addition to a bill that will equally impact all people.  It is quite another to hold out and gain an advantage for only your state.  This bill is loaded with special considerations for a number of states and people.  Nebraska and Louisiana received special funding for their votes.  The tax on Cadillac insurance policies no longer applies equally to all policies; if you are in a certain field of business you will be exempt.  These are only a few.  I’m just not quite understanding the new bill writing system of applying only parts of the bill to some states or some people, while others are exempt, and yet others get special advantages.  Special interests are blaring obvious in this bill.

This got me to thinking of days long ago around this time of year when salesmen used to give gifts to the businessmen who had supported their companies.  Simple gifts, such as fruit baskets, a bottle of alcohol, or tickets to a sporting event.  These were all considered thank you gifts.  But alas, the days quickly ended when these “gifts” became a controversial issue and were then viewed as bribes or kickbacks.  Could one be sure the contract given to company A wasn’t because they gave a fruit basket to some manager who could influence that decision?  The gift giving and acceptance quickly ended with reputable companies for fear of being fired or having criminal charges brought upon them for participating in bribes and kickbacks.  Many scandals resulted from these gift exchanges.

So what makes the deals currently being made in the Senate any less criminal?  Didn’t Senator Ben Nelson actually take a bribe or kickback in exchange for his vote?  He negotiated and accepted a deal that gave a monetary advantage to his state, at the expense of the American taxpayer.  Should we not start holding these people accountable and charging them with the criminal activity they are so blatantly participating in?  The persons offering the bribe/kickback, as well as the person accepting the bribe/kickback, should both be criminally charged for their actions.

If I stood outside a polling place and offered to pay for people to vote a certain way, I am sure I would be quickly stopped, arrested and charged with a crime.  Are the Senators not doing the same thing?  Like I said before, it is one thing to negotiate a provision that will equally affect all.  It is quite another to sell your vote.  It’s time to hold them personally responsible.

A real case of government healthcare…

One of my daughters became pregnant and found to everyone’s surprise she was going to have identical twins.  The news came with mixed emotions as well as difficult decisions.  This was not her first child and she, like many in the family, believes in natural childbirth without medication.  Only her first child was born in a hospital while all the others were born at home with a midwife.

She initially started seeing her midwife for prenatal visits, but when they discovered she was expecting twins the reality of government interference took hold.  The state of Arizona does not allow midwives to knowingly delivery twins, so they had to find a doctor.  They are on the state insurance, which poses it’s own challenges.  However, trying to find a doctor that not only would accept the state insurance but would also deliver twins and accept a patient at 10 weeks became almost an impossible task.  It took her a month to even obtain the booklet of doctors she requested from the state to start her search.  She went through the book and was more often turned down because the doctors no longer accepted the state insurance.  With the help of her midwife and fortunately a state employee willing to help, she was able to obtain the services of a high-risk OB team.

Through the ultrasounds they discovered the babies were identical twins, had separate bags of water but shared one placenta.  This put her in a higher risk category.  At one point during the pregnancy they determined she was experiencing twin-to-twin transfer and was then referred to a specialist.  Because of this the doctors wanted to see her 3 times a week and she underwent regular ultrasounds and non-stress tests.  During her third trimester an ultrasound indicated she actually had two placentas; that there was a division in the placenta that had not previously been noticed; the twins may not be identical.  At that time it was also revealed that she had not actual experienced twin-to-twin transfer, it was only borderline.  With only 4 weeks remaining until her due date the doctor told her she needed to find another doctor because she was now no longer considered high risk!

She took childbirth classes at the hospital she was to deliver at.  She is also a childbirth instructor so these classes were quite unnecessary from a childbirth aspect, but with this unusual pregnancy she wanted to be informed about the hospital, their procedures, as well as the special considerations in delivering twins.

During her regular doctor visits they discussed the expectations of delivery.  This resulted in a difference of opinion from the doctors and expectant parents.  The doctors believed in a medicated birth with a likely outcome of an induced labor as well as a cesarean delivery.  The parents believed in an unmedicated birth, as natural as possible, and only in an emergency to save the mother and/or babies did they want a cesarean.  They created their birth plan and the doctors made their modifications.  They were able to “negotiate” delaying an induction until 38 weeks.

She went in to labor naturally and the first baby came quickly.  They never made it to the hospital.  Labor never stopped and what seemed like a very short time later the second baby was delivered; he was a breech delivery.  Both babies were well and of good size, especially for twins (7 lbs. 14 oz. and 6 lbs. 9 oz.) with the mother and father cooperating during delivery; no one else was present.  This was a Sunday and at this point they did not want to go to the hospital because there was no need.  So they contacted one of their midwifes who came over to make sure mother and babies were okay – everyone was fine.  It also turns out the twins are identical, sharing only one placenta – the latest ultrasounds were wrong!

On Monday morning they contacted the OB doctors and told them the babies were delivered.  The parents asked if they should come in to be seen by the doctors and were told by the doctor’s office that they should come in 2 weeks.  The parents questioned this and the doctors decided they should make an appointment for that Thursday.  Everything seemed fine.

However, the parents received a call from the referring midwife indicating the doctor had issued a 911 call and told her to see the mother and babies immediately.  This second midwife came over Monday and checked everyone out – everyone was fine.

They kept their appointment on Thursday with the doctors, and again everyone was fine – or so they thought.  They expected to return to the doctor for her 6-week visit.

U.S. Senator Roger Wicker

Lost in the ongoing debate over health care reform was a recent decision by Senate Democrats to delay yet again the introduction of their so-called cap-and-trade legislation. The decision, announced earlier this month by Sen. Barbara Boxer, the chairwoman of the Environment and Public Works Committee, is a sign that this misguided legislation has not gained the momentum Democrat leaders had hoped.

In reaction to the announcement, the Wall Street Journal said: “The latest delay is probably a submission to reality, which is a rare thing in the current political environment — and a major victory for the U.S. economy, at least for now.” I agree completely. Considering the blow cap-and-trade legislation would have on family budgets, the nation’s economic recovery, and our long-term competitiveness, the news of the bill’s delay was a welcome development.

The Carbon Tax

The House of Representatives narrowly approved cap-and-trade legislation in June. The legislation would ostensibly curb global warming by reducing the amount of carbon dioxide released into the atmosphere. In order to achieve this, companies that emit carbon dioxide — such as power plants, petroleum refiners, and manufacturers — would be forced to purchase allowances from the federal government for each ton of carbon dioxide emissions they produce.

The cost of these allowances would in effect be a massive tax levied on energy producers, manufacturers and other companies across our economy. This massive new tax would not simply be absorbed by the companies. It would be passed along to consumers by way of higher energy prices. This is not just my prediction. As a candidate for president, then-Sen. Obama admitted: “Under my plan of a cap-and-trade system, electricity rates would necessarily skyrocket.”

Since energy is used to make and provide other goods and services, Americans would see higher prices across the board.  In writing recently about cap-and-trade, Patrick Fleenor, the chief economist at the Tax Foundation, said that “other effects will be less obvious. Food prices will rise because energy is used extensively in the production and transportation of agriculture products.” In fact, during testimony before Congress, the director of the nonpartisan Congressional Budget Office said it was unlikely any consumer product’s price would remain the same under a cap-and-trade program.

Mississippi Impact

A recent study released by the Heritage Foundation provides a window into how a cap-and-trade system would negatively impact Mississippians. The group found that by 2035, Mississippi’s gross state product would be reduced by $3.4 billion if the House-passed cap-and-trade bill became law. Energy prices for everyone in the state would rise. By 2035, the study stated electricity prices would increase by more than $1,000 per household, and Mississippians would pay $1.27 more for a gallon of gasoline.

Cap-and-trade would also severely impact agriculture, our state’s largest employer. Under a cap-and-trade system, the American Farm Bureau Federation reported input costs for agriculture would rise by $5 billion. A recent report by the University of Missouri-Columbia found that under cap-and-trade, a typical corn, soybean, and wheat farm in that state could see increased costs of $11,649 in 2015 and $30,152 in 2050. Results anywhere close to this in Mississippi would be disastrous for the nearly 30 percent of workers in our state employed directly or indirectly by agriculture.

Wrong Direction

Our economy still has a long way to go before fully recovering.  Unemployment has jumped to a 26-year high of 9.7 percent. The last thing our economy needs is for Congress to implement a massive new energy tax that will trickle down and negatively affect every facet of our economy. That is exactly what a cap-and-trade program would do.  Such a scheme is wrong for our country, and I will continue working to ensure its defeat.

How much will the H.R. 3200 cost?  Historically, the cost estimates of every medical program implemented by government has cost more, often significantly more.  Massachusetts passed a universal-coverage plan in 2006, which required all residents to have health coverage and gave subsidies for lower-income uninsured families.  Sounds like the plan the government wants to pass for the country.  The plan was estimated at $472 million for 2008, yet the actual figures for that year were $628 million.  They made some assumptions that proved incorrect.  They assumed that as more people joined the system the premiums would go down across the board.  They further assumed that as more people became insured the number of people visiting the emergency room would drop dramatically.  They assumed this would save them money.  It backfired!  None of these things happened and the health care reform that was supposed to save money has cost more money than expected!

Similar budgetary problems have been seen in Federally run programs.

When Medicare, Part A was established in 1965, covering the hospital insurance portion of the program, the cost was estimated at $9 billion annually by 1990.  The actual spending in 1990 for Part A was $67 billion.

In 1967 the new Medicare program was estimated at $12 billion for 1990.  The actual Medicare spending for the program in 1990 was $110 billion.

A universal entitlement to kidney dialysis was enacted in 1972 at a cost of $100 million for 1974 and actual spending was $229 million for that year.

The DSH program established in 1987 which states use to provide relief to hospitals serving large numbers of Medicaid and uninsured patients was estimated at a cost of less than $1 billion in 1992.  The actual cost for that year was $17 billion.

When Medicare’s home care benefit was changed in 1988 the projected cost for 1993 was $4 billion.  The actual cost in 1993 was $10 billion.

In 1988 a catastrophic coverage benefit was added to Medicare to become effective in 1990.  The cost estimates for this program were initially $5.7 billion and then raised to $11.8 billion, and even the revised number they estimated might be too low.  The program was repealed before it could take effect, largely due to the cost estimates.

The State Children’s Insurance Program in 1997 appropriated $40 billion to states over 10 years, with estimates of $5 billion a year once it was implemented.  By 2006 all unspent reserves were nearly exhausted and Congress appropriated an additional $283 million in 2006 and $650 million in 2007.

Bill H.R. 3200 is estimated at a cost of $1 trillion over the first 10 years and $2.4 trillion over the first 10 years of full implementation.  With the track record of the government grossly underestimating the cost of medical programs, one can only guess what the actual cost will be.  The country already has serious financial problems with spending in the first 8 months of this administration greater than all presidents combined.  The country just cannot afford to invest that amount of money on a program that has been proven in one state not to obtain the desired results at a significant increase in cost.

Under the title of Public Health & Workforce Development are a number of grants, scholarships and other programs, providing training, services and a whole new array of studies relating to health care – a lot of money being spent to support the expansion of government, special interests, illegal immigrants and labor unions, but little to help solve the health care issues.

The first expansion is the establishment of the Public Health Investment Fund, which requires deposits from the revenues of the Treasury in the amount of $88,700,000,000 over 10 years. This money is authorized to be appropriated by the Committee on Appropriations of the House and Senate for carrying out the activities under the designated public health provisions. These areas include Community Health Centers, National Health Service Corps Program, National Health Service Corps Scholarship and Loan Repayment Programs, Primary Care Loan Funds, Primary Care Education Programs, Nursing Workforce Development, The National Center for Health Statistics and the Agency For Healthcare Research and Quality.

To make these programs even more appealing is the stipulation that “Amounts appropriated under this section, and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget solutions for fiscal years during which appropriations are made from the fund.” More spending without any concern for balancing the budget or controlling the country’s deficit. We don’t have it, but let’s spend it!

The first program – Community Health Centers – will obtain increased funding in the amount of $38,800,000,000.

The National Health Service Corps is being amended allowing the Secretary to issue waivers to individuals who enter into a contract for obligated service to pay for their education. It further raises the loan repayment amount from $35,000 to $50,000 and will be adjusted thereafter to reflect inflation. Additional appropriated funds for this program are $796,000,000 over the next 10 years. Additional funding is authorized in the amount of $3,171,000,000 over 10 years to cover the National Health Corps Scholarship and Loan Repayment Programs.

The Frontline Health Providers Loan Repayment Program will be established to address unmet health care needs in certain areas, populations, or facilities as designated by the Secretary. Individuals participating in this program must agree to serve for a period of 2 years in a health professional needs area specified in the program. This program has a clause that if there are an insufficient number of applicants for the program, then all excess funds from the program will be transferred to the National Health Service Corps to recruit more people to take advantage of this fund.

The Secretary shall establish a primary care training and capacity building program consisting of grants and contracts to plan, develop, operate or participate in accredited professional training in the field of family medicine, general internal medicine, general pediatrics or geriatrics. Funds for this program are from the Public Health Investment Fund in the amount of $3,023,000,000 for 10 years and will include the following:

• Capacity Building in Primary Care – grants to specialties of family medicine, general internal medicine, general pediatrics or geriatrics, with preference given to entities that train individuals who are from underrepresented minority groups or disadvantaged backgrounds.
• Training of Medical Residents in Community-Based Setting – a program established for the training of medical residents in community-based settings, with preferences given to entities that support teaching programs addressing the health care needs of vulnerable populations or are a Federally qualified health center or rural health clinic, as well as preference to those training individuals from underrepresented minority groups or disadvantaged background.

• Training for General, Pediatric or Public Health Dentists and Dental Hygienists – grants and contracts to plan, develop, operate or participate in an accredited professional training program or oral health professionals, with preference given to individuals who are from underrepresented minority groups or disadvantaged backgrounds.

Grants for Health Professionals Education – Advanced Education Nursing Grants is being amended, including increases in dollar amounts for the Nurse Faculty Loan Program. Funding for this program is $1, 450,000,000 over 10 years.

The Public Health Workforce Corps is being amended and expanded by the following: Creating the Public Health Workforce Scholarship Program, Public Health Workforce Loan Repayment Program, Enhancing the Public Health Workforce, and Preventive Medicine and Public Health Training Grant Program. Appropriations for these programs total $642,000,000 over 10 years. The Enhancing the Public Health Workforce even includes provisions for veterinary medicine! I’m not sure how veterinarians will provide quality health care to people or decrease health care costs, but it’s nice to see even our animals will be included in the grant programs.

Under the Subtitle “Adapting Workforce to Evolving Health System Needs” there are a number of grants and programs including:

• Health Professionals Training for Diversity, which includes scholarships for disadvantaged students, loan repayments and fellowships regarding faculty positions, and educational assistant in health professions regarding individuals from disadvantaged background.

• The Nursing Workforce Diversity Grants is being amended and adding the Coordination of Diversity and Cultural Competency Programs.

• The Secretary will establish a cultural and linguistic competency training program for health care professionals, including nurses, consisting of grants and contracts to develop and implement models of cultural and linguistic competency training. Preference will be given to entities that address cultural and linguistic needs of the population and health disparities, and placing health professionals in regions experiencing significant changes in the cultural and linguistic demographics of populations, including communities along the United States-Mexico border. Obviously this program will benefit all the illegal immigrants coming from Mexico to obtain free health care.

Appropriations for these programs total $1,138,000,000 over 10 years.

Grants and contracts are given to develop training programs to promote the delivery of health services through interdisciplinary and team-based models, with preferences given to entities that demonstrated training to the greatest number of health professionals who serve in underserved communities.